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Bleeding in the digestive tract.

What Is Bleeding in the Digestive Tract?

Bleeding in the digestive tract is a symptom of digestive problems rather than a disease itself. Bleeding can occur as the result of a number of different conditions, many of which are not life-threatening. Most causes of bleeding are related to conditions that can be cured or controlled, for example, hemorrhoids. And in some cases, eating certain foods can give the appearance of bleeding. The cause may not be serious, but it is important to rule out other possibilities.

When doctors talk about the digestive tract, they mean the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from one or more of these areas, i.e., from a small area such as an ulcer on the lining of the small intestine or from a large surface such as an inflammation of the lining of the colon. Bleeding can sometimes occur without your being able to notice it. This type of bleeding is called "occult" or hidden. Fortunately, there are simple tests for detecting occult blood in the stool.

How Common Is Bleeding in the Digestive Tract?

It is difficult to estimate the incidence of bleeding in the digestive tract. If bleeding hemorrhoids or "piles" are included, it is extremely common. Significant numbers of patients who bleed from the gastrointestinal tract have been found through the use of new methods to test the stool for occult blood. Many patients have abnormalities in the gastrointestinal tract, such as ulcer disease or polyps, that can cause bleeding. Most patients with cancer involving the gastrointestinal tract will bleed either occultly or visibly at some time during the course of their illness.

What Are the Causes of Bleeding in the Digestive Tract?

There are many causes for bleeding in the digestive tract. The most common is probably hemorrhoids. Hemorrhoids are enlarged veins in the anal area that can rupture and produce bright red blood that shows up in the toilet or on toilet paper. If red blood is seen, however, it is essential to rule out other causes of bleeding. The anal area may also be the site of "cuts" (fissures) in the lining, inflammation, or tumors.

Bleeding can come from an inflammation at the lower end of the esophagus caused by acid or bile. This condition is called "esophagitis" or inflammation of the esophagus. Sometimes a weak muscle at the junction of the esophagus and stomach can lead to esophagitis. Enlarged veins (varices) at the lower end of the esophagus may rupture and bleed massively. Cirrhosis of the liver is the most common cause of varices.

The stomach is a common site of bleeding. Alcohol, aspirin, aspirin-containing compounds, and various drugs (particularly those used for arthritis) can cause individual ulcers or diffuse inflammation (gastritis). The stomach is often the site of ulcer disease. Acute or chronic ulcers may enlarge and eat through a blood vessel, causing massive bleeding. Also, patients suffering from burns, shock, head injuries, or cancer, or those who have undergone extensive surgery, may develop "stress ulcers." Bleeding can occur from benign tumors or cancer, although these disorders do not usually cause massive bleeding.

The small intestine is not a common source of bleeding, except for ulcers in the duodenum. In adults, the most common cause of bleeding from the small intestine, other than duodenal ulcers, is Crohn's disease. This disorder results in an inflammation of the bowel wall.

The large intestine (colon) and rectum are common sites of bleeding. Benign growths or polyps of the colon are very common and are thought to be forerunners of cancer. These growths can cause either bright red blood or occult bleeding. Colorectal cancer is the second most common of all cancers in the United States and usually causes bleeding at some time. Inflammation from many causes can produce extensive bleeding from the colon. Various types of intestinal infections can cause inflammation and bloody diarrhea. Ulcerative colitis can produce extensive surface bleeding from very tiny ulcerations. Crohn's disease of the large intestine can produce spotty bleeding. Diverticula-outpouchings of the colon wall-can result, rarely, in massive bleeding. Finally, as one gets older, abnormalities may develop in the blood vessels of the large intestine and those may result in recurrent bleeding.

Are There Genetic or Lifestyle Factors Leading

to Bleeding in the Digestive Tract?

A variety of genetic disorders may be responsible for bleeding in the digestive tract. Certain types of cancers may tend to run in families. Some benign growths that involve the small and large intestines, such as those seen in familial polyposis, are clearly hereditary. Also, hereditary blood vessel disorders may lead to frequent bleeding in the gastrointestinal tract. Finally, there are inherited clotting disorders, such as hemophilia, that can cause bleeding anywhere in the body, with the digestive tract being a common site.

A host of lifestyle factors are thought to contribute to diseases of the digestive tract that can lead to bleeding. Alcohol, drugs, infectious agents, and stress have already been identified. Research indicates that certain dietary patterns may contribute to disorders such as diverticulosis of the colon. Tobacco and coffee may interfere with the healing of peptic ulcer disease and may therefore be indirectly responsible for bleeding. Much more research is needed, however, before the relationship between diet and disease can be established.

How Can You Recognize Bleeding in the

Digestive Tract?

The signs of bleeding in the digestive tract depend upon the site and severity of bleeding. If bleeding is coming from the rectum or the distal colon, there will be bright red blood coating the stool or mixed with the stool. The stool may be mixed with dark red blood if the bleeding is higher up in the colon or at the far end of the small intestine; however, the stool from these areas may be various shades of black. The characteristic appearance of the stool in bleeding from the esophagus, stomach, or duodenum is black or tarry. Vomited material (vomitus) may be bright red or have a coffeegrounds appearance when bleeding is from those sites. If bleeding is occult, the patient will not notice any changes in stool color.

If sudden massive bleeding occurs, there may be weakness, dizziness, faintness, shortness of breath, crampy abdominal pain, and diarrhea. Shock may occur, with a rapid pulse, drop in blood pressure, and difficulty in producing urine. The patient may become very pale. If bleeding is slower and occurs over a long period of time, there may be a gradual onset of fatigue, lethargy, shortness of breath, and pallor from the anemia that results.

How Does the Doctor Diagnose Bleeding in

the Digestive Tract?

It is not difficult to diagnose bleeding in the digestive tract. The problem is locating the site of the bleeding. A complete history and physical examination are essential. Symptoms such as changes in bowel habits, color and consistency of the stool (whether the color is black or red), and the presence of pain or tenderness may tell the doctor which organ is affected. Because the intake of iron and foods such as beets can give the stool the same appearance as bleeding in the digestive tract, a doctor must test the stool for blood before offering a diagnosis. A blood count will indicate whether or not the patient is anemic. It will also give a rough estimate of the extent of the bleeding.

Endoscopy

Several methods are available to locate the source of bleeding. Endoscopy is a diagnostic technique that provides the advantage of direct visualization of the bleeding site. Because the endoscope can detect lesions and confirm the presence or absence of bleeding, doctors often choose this method to diagnose patients with acute bleeding.

The fiberoptic endoscope is a flexible instrument consisting of thousands of tiny glass fibers. It allows the doctor to see into the esophagus, stomach, duodenum, and colon; to perform biopsies; and to take color photographs.

Other Procedures

Several other methods are available to locate the source of bleeding. The single-contrast (barium only) upper gastrointestinal series of x-rays has been found to be about one-half as accurate as endoscopy in identifying the source of bleeding. Double-contrast (barium plus air) x-rays provide a great deal of accuracy. Drawbacks of barium x-rays are that they can lead to complications in surgery, cause inaccuracies in diagnosis if there is massive bleeding, and preclude the use of other diagnostic techniques. In addition, the required number of x-rays may result in repeated exposure to radiation.

Angiography, the visualization of blood vessels after an injection of dye, is generally not as accurate or as sensitive as endoscopy or barium x-ray. The patient must be bleeding briskly for the contrast material to leak out of the blood vessel at the site of the bleeding. It is a procedure that is most useful in those situation in which injection of drugs into the veins is likely to stop the bleeding. Radioactive scanning is a promising, noninvasive, screening technique for locating sites of bleeding, especially in the lower gastrointestinal tract.

How Does the Doctor Treat Bleeding in the

Digestive Tract?

The treatment of bleeding in the digestive tract depends on the cause of bleeding and whether the bleeding is acute or chronic. If aspirin is responsible for the bleeding, eliminate the aspirin and treat the bleeding. If cancer is the cause, removal of the tumors would usually be required. If an ulcer is the cause of the bleeding, the doctor may prescribe a drug, recommend a change in diet, or suggest a change in lifestyle. If acute, life-threatening bleeding is present, emergency measures must be used to prevent or reverse shock. Such measures include hospitalization, blood transfusions, and careful attention to the potential complications of bleeding that may affect the heart, brain, liver, or kidneys. The doctor may advise surgery to control the bleeding if medical measures are not successful.

If bleeding has been slow and chronic and the bleeding has been stopped, blood transfusions may not be necessary. Iron supplements will help restore the body's supply by providing the material needed to manufacture new blood cells.

What Research Is Being Done To Control

Bleeding in the Digestive Tract?

Despite increased accuracy in diagnosing the source of bleeding, bleeding in the digestive tract remains a serious problem. A major task for researchers continues to be investigating new therapies for the different causes of bleeding.

In addition, many researchers are exploring the causes of peptic ulcer disease, gastritis, polyps, cancer, and inflammatory bowel disease. To control gastrointestinal bleeding, researchers are testing a variety of treatments including electrocoagulation and photocoagulation (lasers).

Glossary

Acute. Of short duration.

Anemia. A condition in which the number of red blood cells, the amount of hemoglobin, and the volume of packed red blood cells are less than normal.

Anus. The lower opening of the digestive tract through which fecal matter is discharged.

Barium enema. Lower gastrointestinal (GI) series. A diagnostic procedure in which x-rays are taken after barium sulfate is introduced into the patient by enema. The barium sulfate helps to outline the colon and rectum so that they show up clearly in the x-rays.

Barium meal. Upper GI series. A diagnostic procedure in which the x-rays are taken after the patient swallows barium sulfate. The barium sulfate helps to outline the upper GI tract so that it shows up clearly in the x-rays.

Benign. Noncancerous.

Biopsy. A diagnostic procedure in which a small piece of tissue is removed so that it can be examined under a microscope.

Chronic. Of long duration, often years.

Cirrhosis. A group of chronic liver diseases involving the entire liver, in which liver cells are damaged and regenerate abnormally while much of the liver substance is replaced by scar tissue.

Colitis. Inflammation of the colon.

Colon. The large intestine; the large bowel.

Colonscope. A long, flexible, narrow endoscope used to look into the colon.

Congenital. Present at the time of birth.

Crohn's disease (regional enteritis, ileitis). A chronic, recurring inflammatory disease that can affect any part of the GI tract, but most often the ileum or colon.

Diarrhea. A condition in which fecal matter is discharged from the bowel more often than usual and in a more or less liquid state.

Diffuse. Spread about and not limited to a specific area.

Distal. Farthest away from the trunk, midline, heart, or other reference point.

Diverticulitis. A condition in which diverticula become inflamed.

Diverticulosis. A condition in which there are little sacs (diverticula) on the wall of the colon. This condition is common among older people.

Diverticulum. A little sac that forms on the wall of a hollow organ, usually the colon. The plural form is diverticula.

Duodenum. The first part of the small intestine.

Endoscope. A small, flexible, tube-like instrument, consisting of thousands of tiny glass fibers, that allows a doctor to see into the esophagus, stomach, duodenum, and colon. It also allows a doctor to perform biopsies, take color photographs, and perform surgical and therapeutic procedures.

Endoscopy. A procedure in which an endoscope is used.

Enteritis. Inflammation of the small intestine.

Esophagitis. Inflammation of the esophagus.

Esophagus. The organ that connects the mouth with the stomach.

Familial polyposis. A rare, inherited disease in which many growths (polyps) occur in the colon. There is a very high risk of developing cancer of the colon among those who have this disease.

Feces (stool). Solid body wastes.

Fiber (bulk, roughage). The part of a plant that is not digested. Fiber plays a role in controlling the consistency of stool and the speed at which it is moved down the GI tract.

Fissure. A deep crack.

Gastric ulcer. An open sore on the lining of the stomach.

Gastritis. Inflammation of the stomach.

Gastroenteritis. Inflammation of the lining of both the stomach and the intestine.

Guaiac test (occult blood test). A diagnostic test in which a tiny amount of the material to be tested is rubbed on a slide. A chemical reaction is performed to assess the presence or absence of blood.

Hemorrhage. Bleeding; escape of blood from blood vessels, in microscopic amounts or large volumes.

Hemorrhoids. Enlarged, swollen veins in the anal area.

Hereditary. Passed genetically from parents to children.

Ileum. The lowest part or end of the small intestine.

Inflammation. A condition in which the body is trying to respond to localized injury or destruction of tissues. All or some of these signs are present: redness, swelling, pain, loss of function.

Malignant. Cancerous.

Occult bleeding (hidden bleeding). Bleeding that is not obvious.

Peptic ulcer. An open sore on the lining of the esophagus, stomach, or duodenum. An ulcer of the stomach is called a gastric ulcer; an ulcer in the duodenum, a duodenal ulcer.

Perforated ulcer. An ulcer that has extended through the full thickness of the stomach or the duodenum.

Polyp. Any mass of tissue that bulges up from the normal surface level.

Small intestine. The part of the digestive tube connecting the stomach to the colon. The small intestine is divided into the duodenum, jejunum, and ileum.

Stomach. The large, irregular sac that is found between the esophagus and the small intestine.

Stool. Feces; the waste matter discharged from the body.

Stress ulcers. Acute upper GI ulcers that occur following stressful conditions, e.g., surgery, major burns, or critical head trauma.

Varices. Abnormally dilated (stretched) veins.

What Are the Most Common Causes of Bleeding in the Digestive Tract?
Esophagus Large Intestine
 * Inflammation (esophagitis) and Rectum
 * Enlarged veins (varices) * Hemorrhoids
Stomach * Inflammation
 * Ulcers (ulcerative colitis)
 * Inflammation (gastritis) * Colorectal polyps
 * Colorectal cancer
Small Intestine * Diverticulosis


* Duodenal ulcer * Crohn's disease

How Do You Recognize Blood in the Stool and Vomitus?

* Bright red blood coating the stool

* Dark blood mixed with the stool

* Black or tarry stool

* Bright red blood in the vomitus

* Coffee-grounds appearance of vomitus

What Are the Symptoms of Acute Bleeding?
 * Weakness * Shortness of breath
 * Dizziness * Crampy abdominal pain
 * Faintness * Diarrhea


What Are the Symptoms of Chronic Bleeding?
 * Fatigue * Shortness of breath
 * Lethargy * Pallor


What Is the Digestive Diseases Clearinghouse?

The National Digestive Diseases Information Clearinghouse is a service of the National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases (NIADDK), National Institutes of Health. Mandated by Congress to coordinate a national effort to inform the public, patients and their families, and physicians and other health care providers, the clearinghouse works with other organizations to promote a wider understanding of digestive health and disease. The digestive diseases clearinghouse provides three major types of services: response to and referral of inquiries; development, review, and distribution of publications; and coordination of national resources.

Publications produced by the clearinghouse are carefully reviewed for scientific accuracy, appropriateness of content, and readability. Publications produced by sources other than the clearinghouse are also reviewed by national experts for scientific accuracy and are used, along with clearinghouse publications, to respond to information requests.

National Digestive Diseases Information Clearinghouse

Box NDDIC

Bethesda, MD 20892

(301) 468-6344

NIH Publication No. 89-1133

Reprinted March 1989
COPYRIGHT 1989 National Institute of Diabetes & Digestive & Kidney Diseases
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1989, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
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Author:Sherlock, Paul
Publication:Pamphlet by: National Institute of Diabetes & Digestive & Kidney Diseases
Article Type:pamphlet
Date:Mar 1, 1989
Words:2813
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